Dear Dr. Roach: I am an 83-year-old woman. A month ago, I woke up with vertigo, thought it was caused by a plugged ear, and went to the doctor. He cleaned my ear and told me to return if the vertigo did not go away. It did not. So, I began doing the Epley manoeuvre three times a day, and it subsided. But after three or four days, it came back. I stopped driving. The vertigo persists two weeks later.
Almost everyone I talk to surprisingly has had vertigo or knows someone who has. Research reveals various causes. Eventually, it seems the vertigo goes away. Should I continue with the Epley manoeuvre or seek further treatment?
C.R.
Vertigo is a common problem. One common cause is displaced crystals in the organ of balance, which is what the Epley manoeuvre is for. (You can get instructions on how to do this online or from your doctor.) It is effective in many people, but symptoms can come back. Repeating the manoeuvre can be helpful. If you aren’t undergoing treatment, or if the manoeuvre doesn’t work, symptoms generally go away by themselves after a few weeks.
Acute inflammation of the organ of balance by viruses (known as acute labyrinthitis) causes similar symptoms, usually including nausea, vomiting and difficulty walking. The Epley manoeuvre will not be helpful in this case. Vestibular rehabilitation may be necessary. Meniere’s disease may also look similar, although hearing loss and tinnitus will accompany the vertigo. These may be very subtle early on in the disease. A big clue here is if the recurrences are frequent.
Finally, a brain tumour can rarely be the cause of vertigo. An expert can usually tell by exam whether this is likely. If you aren’t better within a few weeks, you should seek further treatment.
Dear Dr. Roach: I am an 88-year-old healthy man, except for my enlarged prostate. Last week, I gave up self-catheterizing after three years of struggling. I have since developed a urinary tract infection (UTI) and, after taking antibiotics, I still have bacteria in my system. With the recommendation of my urology doctor last week, I had the TURP (transurethral resection of the prostate) operation. The operation went well. I searched, but could not find a permanent cure for the bacteria in my urinary system. I worry it may damage my kidneys. Please advise me on what is the best way to permanently cure or deal with a UTI.
T.P.
It is common to have bacteria in the urine, and it does not always have to be treated. There are some situations where urine infections are treated, such as when they cause symptoms or prior to urological surgery, but it may not be necessary to treat urinary bacteria.
If it is, treatment should be guided by the results of the culture. The lab tests the sensitivity of the bacteria to various antibiotics. Kidney damage is not common with a simple UTI, but if the bacteria make their way up to the kidney, this can end up being a very serious infection.
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